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Epidemiology of CV disease in Central and Eastern Europe

Epidemiology of CV disease in Central and Eastern Europe. Renata C í fkov á Center for CV Prevention, Charles University Medical School & Thomayer University Hospital Department of Medicine II, Charles University Medical School Department of Preventive Cardiology , IKEM

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Epidemiology of CV disease in Central and Eastern Europe

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  1. Epidemiology of CV disease in Central and Eastern Europe Renata Cífková Center for CV Prevention, Charles University Medical School & Thomayer University Hospital Department of Medicine II, Charles University Medical School Department of Preventive Cardiology, IKEM Prague, Czech Republic

  2. Death by cause Europe MenWomen All CVD deaths 43% All CVD deaths 54% European CVD Statistics 2008

  3. Death by cause European Union MenWomen All CVD deaths 38% All CVD deaths 45% European CVD Statistics 2008

  4. Russian Fed. Bulgaria Romania Hungary Poland Argentina Czech Republic China-Rural Colombia China-Urban Scotland Ireland Finland N. Ireland Greece England/Wales Belgium USA Denmark N. Zealand Mexico Germany Portugal Sweden Korea Austria Netherlands Italy Norway Canada Spain Australia France Switzerland Israel Japan DeathRatesfor CVD andStroke Men, 35-74 yrs Circulation 2009;119:e21-e181

  5. Death Rates for CVD and Stroke Women, 35-74 yrs Russian Fed. Bulgaria Romania Hungary Colombia China-Rural China-Urban Argentina Poland Czech Republic Mexico Puerto Rico Scotland N.Ireland USA England/Wales New Zealand Greece Korea Ireland Denmark Belgium Portugal Germany Sweden Finland Netherlands Canada Italy Austria Norway Australia Israel Spain Switzerland Japan France Circulation 2009;119:e21-e181

  6. CV Mortality - Males Dearth/100 000 (age adj.) year

  7. CV Mortality - Females Death/1000 000 (age adj. year

  8. Standardized mortality CzechRepublic, 2009 Females Males 51.4 % 22.5 % 45.3 % 26.8 % 27.9 % 26.1 % CVD Malignancies Other

  9. Age-adjusted death rates/100,000 Czech Republic, 1985-2009 1985 2009 % p Males - Total - CVD - CHD - Stroke Females - Total - CVD - CHD - Stroke < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 - 38.8 - 48.3 - 47.9 - 64.4 - 38.9 - 46.0 - 39.9 -64.4 1581 844 436 250 944 548 223 202 963 436 218 89 577 296 134 72

  10. Age-stand. total, CVD, IHD, and stroke mortality (age group 35-74 yrs) Czech Republic 1970-2008 Males Females Number of deaths/100,000 Number of deaths/100,000 Total mortality CVD mortality IHD mortality Stroke mortality J Hypertens 2010;28:2196-203

  11. CVD mortality, age 35-74 years Males vs Females: p = 0,001 Total mortality, age 35-74 years Males vs Females: p = 0,001 Number of deaths/100,000 Number of deaths/100,000 year year Males Females Stroke mortality, age 35-74 years Males vs Females: p = 0,0041 CAD mortality, age 35-74 years Males vs Females: p = 0,001 Number of deaths/100,000 Number of deaths/100,000 year year J Hypertens 2010;28:2196-203

  12. Factors affecting CHD mortality Risk factors Treatment Case fatality CHD incidence CHD mortality

  13. WHO MONICA projekt Nové okresy Litoměřice Cheb Pardubice Praha východ Plzeň Chrudim Kroměříž Benešov Jindřichův Hradec

  14. Sample sizes and response rates 1985 1988 1992 1997/8 2000/1 2007/8 2768 1357 85.5 1411 88.4 Total Males Resp. Females Resp. 2343 1134 73.2 1209 76.7 2570 1253 81.5 1317 85.0 1990 969 63.2 1021 66.4 2055 1003 62.0 1052 63.8 2246 1102 62.7*** 1144 63.1*** *** p < 0.001 for trend

  15. Systolic BP MalesFemales mmHg mmHg p < 0.001 p < 0.001 Atherosclerosis 2010;211:676-81

  16. Diastolic BP MalesFemales mmHg mmHg p < 0.001 p < 0.001 Atherosclerosis 2010;211:676-81

  17. Prevalence of hypertension MalesFemales % % p < 0.001 p for linear trend: ns Atherosclerosis 2010;211:676-81

  18. BMI MalesFemales kg/m2 kg/m2 p < 0.001 p pro trend: NS Atherosclerosis 2010;211:676-81

  19. Awareness of hypertension MalesFemales % % p for linear trend: 0.001 p for linear trend: 0.001 Atherosclerosis 2010;211:676-81

  20. Antihypertensivemedication MalesFemales % % p for linear trend: 0.001 p for linear trend: 0.001 Atherosclerosis 2010;211:676-81

  21. Hypertension control BP < 140/90 mmHg of allhypertensives MalesFemales % % p for linear trend: 0.001 p for linear trend: 0.001 Atherosclerosis 2010;211:676-81

  22. Total cholesterol Males Females mmol/l mmol/l p < 0.001 p < 0.001 Atherosclerosis 2010;211:676-81

  23. Lipid-lowering drugs 2000/01 n = 171 (5.1%) 1997/98 n = 130 (3.95%) 2007/08 n = 386 (10.7%) 3% 3% 4.7% 4% 13% 27.5% 15.5% 1.6% 81% 68.5% 78.0% fibrates statins other combinations Atherosclerosis 2010;211:676-81

  24. Smoking Males Females % % p < 0.001 p for trend: n.s. Atherosclerosis 2010;211:676-81

  25. Conclusions Total and CV mortality is decreasing in the Czech Republic. The decrease is due to decreasing stroke and CHD mortality rates.

  26. Explaining the CHD mortality fall in the Czech Republic 1985-2007: RESULTS • Risk Factors worse + 6% • Risk Factors better -61% • Treatments -41% • Unexplained -4% 12,080 fewer deaths in 2007  1985 2007

  27. Explaining the CHD mortality fall in theCzech Republic1985-2007: RESULTS • Risk Factors worse +6% • Obesity (increase) +1% • Diabetes (increase) +5% • Risk Factors better -61% • Population BP fall -15% • Smoking -8% • Cholesterol (diet)-38% • Treatments -41% • AMI treatments -7% • Unstable angina -1% • Secondary prevention post MI • and post revasc. -11% • Heart failure -13% • Angina: CABG surgery -1.5% • Angina ASA -1% • Hypertension therapies -3% • Statins (primary prevention) -4% • Unexplained -4% 12,080 fewer deaths in 2007  2007 1985

  28. PercentageoftheDecrease in Deathfrom CHD Atributed to Treatmentand Risk-FactorsChanges NEJM 2007;356:2388-98

  29. Systolic BP German CV Prevention Study Males Females ns * * mmHg Preventive Medicine 1994;23:197-205

  30. Diastolic BP German CV Prevention Study Males Females * mmHg Preventive Medicine 1994;23:197-205

  31. BMI German CV Prevention Study Females Males * * kg/m2 Preventive Medicine 1994;23:197-205

  32. Smoking German CV Prevention Study Males Females % % Preventive Medicine 1994;23:197-205

  33. Total Cholesterol German CV Prevention Study Females Males mmol/L mmol/L * * * Preventive Medicine 1994;23:197-205

  34. HDL-cholesterol German CV Prevention Study Males Females mmol/L mmol/L Preventive Medicine 1994;23:197-205

  35. Kaunas Population, Lithuania Age range, 35-64 yrs 1983/84 1986/87 1992/93 2001/02 Total Resp. 2413 70.2 1762 69.6 1231 58.6 1403 62.4 Medicina 2003;39:1193-1199

  36. Systolic BP Kaunas, Lithuania Males Females p < 0.001 ** ** mmHg Medicina 2003;39:1193-1199

  37. Diastolic BP Kaunas, Lithuania Males Females *** *** mmHg Medicina 2003;39:1193-1199

  38. BMI Kaunas, Lithuania Females Males *** kg/m2 *** * Medicina 2003;39:1193-1199

  39. Total Cholesterol Kaunas, Lithuania Females Males mmol/L mmol/L *** *** * * p < 0.001 Medicina 2003;39:1193-1199

  40. WHO MONICA Project Multinational MONItoring of Trends and Determinants in CArdiovascular Disease 38 populations in 21 countries • monitoring of nonfatal MI and CHD deaths in males and females aged 35-64 years • cross-sectional population surveys of major RF

  41. WHO MONICA Age-standardized SBP Men, 35-64 years BEL-GHE CAN-HAL CZE-CZE GER-AUR GER-AUU GER-BRE GER-EGE ITA-BRI NEZ-AUC POL-TAR POL-WAR RUS-MOC RUS-MOI RUS-NOC RUS-NOI UNK-BEL UNK-GLA USA-STA YUG-NOS MEAN Lancet 2000; 355:675-87

  42. WHO MONICA Age-standardized SBP Women, 35-64 years BEL-GHE CAN-HAL CZE-CZE GER-AUR GER-AUU GER-BRE GER-EGE ITA-BRI NEZ-AUC POL-TAR POL-WAR RUS-MOC RUS-MOI RUS-NOC RUS-NOI UNK-BEL UNK-GLA USA-STA YUG-NOS MEAN Lancet 2000; 355:675-87

  43. WHO MONICA Smokers Men, 35-64 years BEL-GHE CAN-HAL CZE-CZE GER-AUR GER-AUU GER-BRE GER-EGE ITA-BRI NEZ-AUC POL-TAR POL-WAR RUS-MOC RUS-MOI RUS-NOC RUS-NOI UNK-BEL UNK-GLA USA-STA YUG-NOS MEAN Lancet 2000; 355:675-87

  44. WHO MONICA Smokers Women, 35-64 years BEL-GHE CAN-HAL CZE-CZE GER-AUR GER-AUU GER-BRE GER-EGE ITA-BRI NEZ-AUC POL-TAR POL-WAR RUS-MOC RUS-MOI RUS-NOC RUS-NOI UNK-BEL UNK-GLA USA-STA YUG-NOS MEAN Lancet 2000; 355:675-87

  45. WHO MONICA Total cholesterol Men, 35-64 years BEL-GHE CAN-HAL CZE-CZE GER-AUR GER-AUU GER-BRE GER-EGE ITA-BRI NEZ-AUC POL-TAR POL-WAR RUS-MOC RUS-MOI RUS-NOC RUS-NOI UNK-BEL UNK-GLA USA-STA YUG-NOS MEAN Lancet 2000; 355:675-87

  46. WHO MONICA Total cholesterol Women, 35-64 years BEL-GHE CAN-HAL CZE-CZE GER-AUR GER-AUU GER-BRE GER-EGE ITA-BRI NEZ-AUC POL-TAR POL-WAR RUS-MOC RUS-MOI RUS-NOC RUS-NOI UNK-BEL UNK-GLA USA-STA YUG-NOS MEAN Lancet 2000; 355:675-87

  47. WHO MONICA BMI Men, 35-64 years BEL-GHE CAN-HAL CZE-CZE GER-AUR GER-AUU GER-BRE GER-EGE ITA-BRI NEZ-AUC POL-TAR POL-WAR RUS-MOC RUS-MOI RUS-NOC RUS-NOI UNK-BEL UNK-GLA USA-STA YUG-NOS MEAN Lancet 2000; 355:675-87

  48. WHO MONICA BMI Women, 35-64 years BEL-GHE CAN-HAL CZE-CZE GER-AUR GER-AUU GER-BRE GER-EGE ITA-BRI NEZ-AUC POL-TAR POL-WAR RUS-MOC RUS-MOI RUS-NOC RUS-NOI UNK-BEL UNK-GLA USA-STA YUG-NOS MEAN Lancet 2000; 355:675-87

  49. Conclusions • CVD mortality in all European post-Communist countries is the highest in Europe. • In fact, CVD mortality rates continue to rise in most post-Communist countries in Europe except for the Czech Republic, Poland, and Slovenia.

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